A 68-year-old man comes to the physician for a 3-month history of pain in his buttocks and thighs when walking around the block. He had coronary artery bypass grafting performed 4 years ago. He has smoked one pack of cigarettes daily for 50 years. Blood pressure is 140/90. Current medications are atorvastatin, lisinopril, and aspirin. Physical examination shows loss of hair over the shins. There is no hyperpigmentation or peripheral edema. Popliteal and dorsalis pedis pulses are reduced. Jugular venous pulsations are 3cm above the sternal angle. Which of the following is the next best step in diagnosis for this patient’s acute presentation?
Ankle-brachial indices
Arteriography
Duplex ultrasonography
Echocardiography
Exercise stress testing
